Current therapy and ongoing advances

This review discusses current therapy as well as ongoing advances in the treatment of non small-cell lung cancer.

Many advances have been made in recent years in the treatment of non small-cell lung cancer (NSCLC). New technologies used in radiation therapy are allowing for a more targeted and precise delivery of radiation. By characterizing tumor cells at the genetic and molecular level, chemotherapy drugs can be directly targeted only to selected cancer cells. The current review discusses the chemotherapy and radiotherapy standards currently in use, as well as new advances being made.

The standard treatment for inoperable NSCLC is a combined delivery of chemotherapy and radiation therapy. This combination has been shown to increase survival rates compared to sequential treatments (receiving treatments one after the other). Some chemotherapy combinations, such as cisplatin with etopside or carboplatin with paclitaxel, have been found to be specifically useful when used together with radiation therapy. A new combination includes pemetrexed (Alimta) with carboplatin, given simultaneously with radiotherapy. This combination has been found to lead to an 18 month survival rate of more than 55%.  

Patients with a form of NSCLC caused by an epidermal growth factor receptor (EGFR) mutation have been shown to benefit from EGFR inhibitors, such as gefitinib and erlotinib, prior to chemotherapy and radiation therapy. However, the use of these drugs after chemotherapy and radiotherapy treatments is of unclear benefit.

A new drug, L-BLP25, targets a common complex called MUC-1, found on the surface of many NSCLC cells. In a small phase II study involving stage III patients, L-BLP25 in combination with chemotherapy resulted in an average survival of 30.6 months, compared to 13.3 months without the drug. Therefore, two large phase III studies investigating the benefit of L-BLP25 are currently underway.

This review illustrated that combined chemoradiotherapy is important in the management of non small-cell lung cancer.